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Global Database on Child Growth and Malnutrition

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Child growth indicators and their interpretation

In children the three most commonly used anthropometric indices to assess their growth status are weight-for-height, height-for-age and weight-for-age. These anthropometric indices can be interpreted as follows:

Low weight-for-height: Wasting or thinness indicates in most cases a recent and severe process of weight loss, which is often associated with acute starvation and/or severe disease. However, wasting may also be the result of a chronic unfavourable condition. Provided there is no severe food shortage, the prevalence of wasting is usually below 5%, even in poor countries. The Indian subcontinent, where higher prevalences are found, is an important exception. A prevalence exceeding 5% is alarming given a parallel increase in mortality that soon becomes apparent (2). On the severity index, prevalences between 10-14% are regarded as serious, and above or equal 15% as critical. Typically, the prevalence of low weight-for-height shows a peak in the second year of life. Lack of evidence of wasting in a population does not imply the absence of current nutritional problems: stunting and other deficits may be present (3).

High weight-for-height: "Overweight" is the preferred term for describing high weight-for-height. Even though there is a strong correlation between high weight-for-height and obesity as measured by adiposity, greater lean body mass can also contribute to high weight-for-height. On an individual basis, therefore, "fatness" or "obesity" should not be used to describe high weight-for-height. However, on a population-wide basis, high weight-for-height can be considered as an adequate indicator of obesity, because the majority of individuals with high weight-for-height are obese. Strictly speaking, the term obesity should be used only in the context of adiposity measurements, for example skinfold thickness.

Low height-for-age: Stunted growth reflects a process of failure to reach linear growth potential as a result of suboptimal health and/or nutritional conditions. On a population basis, high levels of stunting are associated with poor socioeconomic conditions and increased risk of frequent and early exposure to adverse conditions such as illness and/or inappropriate feeding practices. Similarly, a decrease in the national stunting rate is usually indicative of improvements in overall socioeconomic conditions of a country. The worldwide variation of the prevalence of low height-for-age is considerable, ranging from 5% to 65% among the less developed countries (4). In many such settings, prevalence starts to rise at the age of about three months; the process of stunting slows down at around three years of age, after which mean heights run parallel to the reference. Therefore, the age of the child modifies the interpretation of the findings: for children in the age group below 2-3 years, low height-for-age probably reflects a continuing process of "failing to grow" or "stunting"; for older children, it reflects a state of "having failed to grow" or "being stunted". It is important to distinguish between the two related terms, length and stature: length refers to the measurement in recumbent position, the recommended way to measure children below 2 years of age or less than 85 cm tall; whereas stature refers to standing height measurement. For simplification, the term height is used all throughout the database to cover both measurements.

Low weight-for-age: Weight-for-age reflects body mass relative to chronological age. It is influenced by both the height of the child (height-for-age) and his or her weight (weight-for-height), and its composite nature makes interpretation complex. For example, weight-for-age fails to distinguish between short children of adequate body weight and tall, thin children. However, in the absence of significant wasting in a community, similar information is provided by weight-for-age and height-for-age, in that both reflect the long-term health and nutritional experience of the individual or population. Short-term change, especially reduction in weight-for-age, reveals change in weight-for-height. In general terms, the worldwide variation of low weight-for-age and its age distribution are similar to those of low height-for-age.